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There were many causes of this famine. The direct cause was the effects of World War II on French Indochina. The involvement of France and Japan in Vietnam caused detrimental effects to the economic activities of the Vietnamese. Military and economic changes[specify] caused the northern part of the country to plunge into famine.

Indirectly, the mismanagement of the French administration in Vietnam played a role. The French reformed the economy in order to serve the administration and to meet the needs of war, because they were being invaded themselves. Natural causes included natural disasters such as droughts and floods destroying northern crops.

After the Great Depression in the 1930s, France returned to its policy of economic protectorate and monopolized the exploitation of natural resources of Indochina. The people in Indochina had to increase the economic value of the area by growing cash crops in place of lower-value agricultural produce, but only the French and a small minority of Vietnamese and Hoa and some people in the cities benefited. When the war started, France was weakened. In East Asia, Japan began to expand and viewed Indochina as a bridge into Southeast Asia and a means to isolate and further weaken the Nationalist governmentChina. In mid-1940, metropolitan France was occupied by Nazi Germany and Japan increased pressure on France and entered Indochina that September. Vietnam was pulled into a wartime economy, with France and Japan competing in administration. Many people blame the famine on Japanese troops hoarding foodstuff from farmers, forcing them to grow jute instead of rice, thus depriving them of needed food, but in reality France had started the same policy earlier. They had decreased the land set aside for growing staple crops such as maize and potatoes to make land for growing cotton, jute, and other industrial plants. Because of the decreased land available for growing, harvests of staple crops decreased considerably.

During the occupation of French Indochina by Japan, the Allies made frequent air strikes against roads, warehouse and transportation facilities. This made the transport of rice from the south to the north extremely difficult. The prices of essential goods, especially foodstuff, skyrocketed. The militaries of both France and Japan forcibly seized food from farmers to feed their troops. In the meantime, the French civilian administration was dysfunctional, unable to distribute remaining food stocks to areas where needed. In March 1945, Japanese-sponsored Empire of Vietnam headed by Trần Trọng Kim supplanted the French administration. While this new government made efforts to alleviate the famine, the inadequate food supply coupled with hoarding of food by the Japanese Army, made their efforts futile.

In northern Vietnam, a drought coupled with pests caused the winter-spring harvest of 1944 to decrease by 20%. After that there was a flood during the harvest season, causing the crisis to occur. This hence led to the famine in 1945.

The exact number of deaths due to the 1944-1945 famine is unknown and is a matter of controversy.Various sources estimate between 400,000 to 2 million peopled starved in northern Vietnam during this time. In May 1945, the envoy at Hanoi asked the northern provinces to report their casualties. Twenty provinces reported that a total of 380,000 people starved to death, and 20,000 more died because of disease. In October, a report from a French military official estimated half a million deaths. The French Governor General Jean Decoux wrote in his memoirs A la barre de l'Indochine that about 1 million northerners starved to death. Modern Vietnamese historians estimate between 1 and 2 million deaths. Ho Chi Minh in his Proclamation of Independence of the Democratic Republic of Vietnam on September 2, 1945 used a 2 million figure.

The famine played a part in the coming war between the French and Viet Minh. In March 1945 the Viet Minh (a communist controlled common front fighting for the independence of Vietnam) urged the population to ransack rice warehouses and refuse to pay their taxes. Between 75 and 100 warehouses were consequently raided. This rebellion against the effects of the famine and the authorities that were seen as responsible for it bolstered the Viet Minh's popularity and they recruited many members during this period.